Tillou X, Raynal G, Demailly M, Hakami F, Saint F, Petit J
Service d'Urologie-Transplantation, CHU Sud, Avenue Laennec, 80000 Amiens, France.
Transplant Proc. 2009 Oct;41(8):3317-9. doi: 10.1016/j.transproceed.2009.08.046.
To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis.
From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment.
Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy (n = 21) or after Politano-Leadbetter anastomosis (n = 22). The success rate of endoscopic management was 75% (n = 16) for Politano-Leadbetter anastomosis versus 53% (n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference (P = .1).
Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.
根据输尿管吻合术的类型，评估输尿管支架置入术治疗肾移植术后泌尿系统并发症或为手术治疗做准备的成功率。
1989年5月至2006年12月，我们共进行了703例肾移植手术，其中412例采用膀胱外输尿管膀胱吻合术（根据利奇-格雷戈瓦技术），265例采用经膀胱输尿管膀胱吻合术（根据波利塔诺-利德贝特技术）。我们回顾性分析了对尿漏和输尿管狭窄的内镜治疗情况。成功的标准是能够置入输尿管支架，在进一步进行内镜或手术治疗前使移植肾的上尿路得到良好引流。
膀胱外输尿管膀胱吻合术后（n = 21）或波利塔诺-利德贝特吻合术后（n = 22）发生了43例尿漏或输尿管狭窄。波利塔诺-利德贝特吻合术的内镜治疗成功率为75%（n = 16），而利奇-格雷戈瓦吻合术为53%（n = 11）。两者无统计学差异（P = 0.1）。
根据利奇-格雷戈瓦手术进行的输尿管膀胱吻合术的并发症比根据波利塔诺-利德贝特技术进行的手术少一半，但紧急情况下输尿管支架置入失败率高于25%。
